PB2460: THE RATE OF NEUTROPHIL RECOVERY IS HELPFUL IN PREDICTING ACUTE GRAFT-VERSUS-HOST DISEASE AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION: AN OBSERVATIONAL COHORT STUDY
Authors: Sihan Lai, Xue LI, Ying He, Shan Zhang, Guangcui He, Yan Deng, Ying Han, Hai Yi
Journal: HemaSphere (2023)

Topic: 22. Stem cell transplantation - Clinical Background: Severe acute graft-versus-host disease (aGVHD) is an important cause of death in the early post-transplant period. Hence, prevention and early intervention of GVHD is a main approach to enhance the survival of recipients after transplantation. To improve the prognosis of allo-HSCT recipients, it is particularly important to predict the occurrence of GVHD early before the clinical manifestations appear. Therefore, there is an urgent need to discover new non-invasive early prediction methods with potential applications. In this study, we investigated the dynamic changes of leukocytes and neutrophils in patients with hematological diseases after transplantation, analyzed the relationship between the trend of index changes and aGVHD, and initially explored the predictive value of leukocyte and neutrophil changes for aGVHD, aiming to provide some reference for early diagnosis and treatment of aGVHD. Aims: To observe and analyze the correlation between the occurrence of acute graft-versus-host disease (aGVHD) and blood routine after allogeneic hematopoietic stem cell transplantation (allo-HSCT） in patients with hematological diseases. Methods: 79 hospitalized patients with hematological diseases who underwent allo-HSCT in the Department of Hematology, the General Hospital of Western Theater Command from December 2020 to December 2021 were selected as study subjects, and their clinical data were retrospectively analyzed to explore the correlation between aGVHD and the changes in blood routine, and to provide a diagnostic basis for further clinical treatment and prevention. Results: Among the 79 patients, 22 cases (27.85%) suffered from aGVHD and 57 cases (72.15%) did not. Age, the neutrophil count on the second day after implantation (NEU d2) and the neutrophil count on the third day after implantation (NEU d3) were the factors influencing the occurrence of aGVHD. The NEU d3 was 3.06 (2.44, 3.93) × 10^9/L in the group with aGVHD, while it was 1.46 (0.97, 2.69) × 10^9/L in the group without aGVHD. Therefore, the NEU d3 in the group with aGVHD was significantly higher than that without aGVHD (P < 0.05). When the cut-off value of the NEU d3 was 2.44, the AUC was 0.74 (95% CI 0.63-0.86), the sensitivity was 0.77, and the specificity was 0.73. The NEU d3 ≥2.44 was considered as high neutrophil group, while the NEU d3 <2.44 was considered as low neutrophil group. The survival analysis revealed that the incidence of aGVHD after allo-HSCT in the high neutrophil group was significantly higher than that in the low neutrophil group (P < 0.001). Thus, we proposed that NEU d3 ≥2.44 be an independent predictor for the occurrence of aGVHD after allo-HSCT. Summary/Conclusion: Patients with hematological diseases can achieve better clinical remission after allo-HSCT, but the occurrence of aGVHD is still a great challenge for patient survival after allo-HSCT. The rate of neutrophil recovery after allo-HSCT can be one of the judgment indicators for the occurrence of aGVHD after transplantation, and the clinical value needs to be verified by a prospective, large sample, randomized trial. Keywords: Allogeneic hematopoietic stem cell transplant, Graft-versus-host disease (GVHD)